If you or a loved one are one of the 8,000 Albertans1 living with Parkinson’s disease (PD) you may already be aware of the effect PD can have on quality of life. PD is a slowly progressive neurological condition that affects both men and women equally. Early signs of PD include taking shorter steps, your hand or head shaking, your voice becoming less strong or your handwriting becoming smaller and harder to read.1,2 Other symptoms include fatigue, anxiety, depression, short-term memory loss, sleep disruptions, and difficulty chewing or swallowing, speaking or managing daily tasks such as dressing.1,2 The average age of diagnosis is 56, but about 20 percent of individuals are diagnosed before they are 50.1
There are no simple diagnostic tests for PD, so diagnosis is usually based on the presence of several of these symptoms:2
You notice you are moving more slowly or having difficulty starting to move (freezing).
Your arm and leg muscles feel stiffer and harder to move (rigidity).
Your hands or head shake at rest (tremors).
You notice changes in your balance and posture.
If you have been diagnosed with PD it is important to stay active. The 2019 Canadian Guidelines for the treatment of Parkinson’s disease recommend starting an exercise routine as early as possible to help manage the disease.2,3 PD cannot be cured, but regular physical activity helps maintain physical health and can improve the mental well-being of those living with the disease.2
How exercise and physiotherapy can help
A physiotherapist can work with you to manage your Parkinson’s through all stages of the disease. The primary goal of physiotherapy is to assist individuals to remain as independent and safe as possible while living the life they want.4 A physiotherapy program that focuses on exercise, education, and support for the whole person is vital for success.4
Research suggests that exercise targeted to your unique challenges can help manage or improve the symptoms you experience.3 A physiotherapist will assess how the condition has affected your balance and overall ability to move. They will then develop a program of exercises and other strategies to improve your mobility and maintain your independence for as long as possible.
Some of the benefits of physiotherapy may include:3
Improving your walking speed
Reducing the stiffness in your arms and legs
Making it easier to get up and go
Improving your balance and decreasing your risk of falling
Improving your overall fitness and general health
Exercises you might expect
Just as the type and severity of the physical symptoms of Parkinson’s are different from person to person, the type of physical activities or recommended exercises will differ for each individual. However, programs typically include some of the following:3,4,5
Walking and balance exercises
A walking and balance exercise program can help increase your walking speed, improve your balance and prevent falls. Participating in balance activities prescribed by your physiotherapist or as part of a physiotherapist-led group class, enrolling in a community tai chi class or enjoying a dance class are great places to start.4,5
Over time, people with Parkinson’s may develop a stooped posture because their trunk becomes stiff and trunk muscles become tight and weak. The combination of a stooped posture and trunk stiffness can make balance, mobility, breathing and swallowing more difficult.2 Adding posture and back or abdominal strengthening exercises can help maintain or improve posture and make moving around easier and safer.
General flexibility and strengthening exercises
Maintaining good muscle strength in your arms and legs is important to your ability to move and function in your home or community safely. A well-rounded set of simple stretching and strengthen exercises should be part of your normal wellness program.
Aerobic activities (e.g., treadmill, biking or dancing)
Aerobic exercise can have significant health benefits for those with PD. Aerobic exercises can improve breathing, overall physical fitness and improve your outlook on life. Some experts suggest that exercises like treadmill walking or biking that requires keeping up to a certain pace may slow progression of the disease.4,5
Although the evidence does not identify one type of exercise program as the best, it does show that treatment plans needed to be flexible, and available in the community.4 What’s most important is that the exercise is tailored to fit your unique symptoms and preferences and that you start early.3
Participating in a formal group exercise class designed for individuals with Parkinson’s disease can be a good place to start and can provide additional benefits such as general education about the disease, strategies to manage common challenges, peer support and increased motivation to participate.5
One of the major difficulties people with Parkinson’s disease experience can be freezing, or difficulty starting a movement. Taking a step, getting out of a chair or turning over in bed can become a challenge. Training that involves the use of rhythmical movements (e.g., marching) along with auditory rhythms (e.g., metronome) are strategies that physiotherapists may use to help you move more freely and reduce the frequency or severity of freezing on your function4 and can be used in day-to-day activities to help manage this symptom.
There is also some evidence that, if you have been involved in and graduated from a Parkinson’s disease exercise group in the past, returning for a “booster shot” of exercise can help to prolong the benefits of that initial training.3,4
Everyone’s experience with PD will be different so living well with this disease requires an individualized plan that considers all aspects of your lifestyle. If you enjoy the activities that you are doing, this increases the chances that you will continue to participate, and lead to long-term benefits and a slowing of the progression of symptoms.3,4
Although the availability and ability to participate in group classes for people with PD may be limited due to the COVID-19 pandemic, one-on-one treatment with a physiotherapist is increasingly available and some physiotherapists also offer online treatment or group classes to help people with PD manage their symptoms while also limiting their risk of contracting the virus. Delaying treatment can have negative effects, so looking into the treatment options available in the context of COVID-19 is important.
Before starting any new exercise, consult with a physiotherapist for advice on which activities are most suited to you and your symptoms.
Parkinson Association of Alberta. Parkinson disease. Available at http://parkinsonassociation.ca/buchanan-parkinson-disease Accessed Jan 27, 2020. https://www.parkinson.ca/about-parkinsons/understanding-parkinsons/ Access Jan 27, 2020.
Grimes D, Fitzpatrick M, Gordon J, Miyasaki J, Fon EA, Schlossmacher M, et al. Canadian guideline for Parkinson disease. CMAJ Sep 2019, 191 (36) E989-E1004; DOI: 10.1503/cmaj.181504 Available at https://www.cmaj.ca/content/191/36/E989 Accessed Jan 27, 2020.
Tomlinson CL, Herd CP, Clarke CE, Meek C, Patel S, Stowe R et al. Physiotherapy for Parkinson’s disease: a comparison of techniques. Cochrane Database of Systematic Review. June 17, 2014. Accessed Feb 11, 2020.
Goodwin LS, Lan L. Evaluation and delivery of ambulatory rehabilitation for people with Parkinson’s disease. Reviews in Clinical Gerontology 2014; 24:122-138. Accessed Jan 27, 2020
Regulating Alberta's physiotherapy profession and acting as an association by providing member services.